Implant surface preparation

ABSTRACT

The surface of a device that is surgically implantable in living bone is prepared. The device is made of titanium with a native oxide layer on the surface. The method of preparation comprises the steps of removing the native oxide layer from the surface of the device and performing further treatment of the surface substantially in the absence of unreacted oxygen.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. application Ser. No.11/651,115 filed Jan. 9, 2007 (issued as U.S. Pat. No. 7,547,399); whichis a continuation of U.S. application Ser. No. 11/172,775 filed Jul. 1,2005 now U.S. Pat. No. 7,169,317; which is a continuation of U.S.application Ser. No. 10/701,855 filed Nov. 5, 2003 (issued as U.S. Pat.No. 6,969,474); which is a continuation of U.S. application Ser. No.09/777,335 filed Feb. 6, 2001 (issued as U.S. Pat. No. 6,652,765); whichis a continuation of U.S. patent application Ser. No. 09/259,432 filedMar. 1, 1999 (issued as U.S. Pat. No. 6,491,723), which is acontinuation of U.S. patent application Ser. No. 08/607,903, filed Feb.27, 1996 (issued as U.S. Pat. No. 5,876,453), which claims priority ofPCT/US95/15576, filed on Nov. 30, 1995, and which is acontinuation-in-part of U.S. patent application Ser. No. 08/351,214,filed Nov. 30, 1994, (now abandoned) for “Implant Surface Preparation.”

FIELD OF THE INVENTION

The present invention relates to processes for improving the surfaces ofdevices to be surgically implanted in living bone, and to implantdevices having the improved surfaces.

BACKGROUND OF THE INVENTION

The success of prosthetic devices surgically implanted in living bonedepends substantially entirely on achieving and maintaining an enduringbond between the confronting surfaces of the device and the host bone.Surgical procedures for preparing living bone to receive a surgicallyimplanted prosthetic device have been known for twenty years or more,but considerable controversy remains concerning the ideal properties ofthe surface of the device which confronts the host bone.

It is known through clinical experience extending over several decadesthat titanium and its dilute alloys have the requisite biocompatabilitywith living bone to be acceptable materials for use in making surgicallyimplantable prosthetic devices, when the site of installation isproperly prepared to receive them. There is, however, less certaintyabout the ideal physical properties of the surfaces of the prostheticdevices which confront the host bone. For example, the endosseous dentalimplant made of titanium enjoys sufficient predictable success to havebecome the artificial root most frequently chosen for restoringdentition to edentulous patients, but that success depends in part onthe micromorphologic nature of the surface of the implant which comes incontact with the host bone. Because there is no standard for the surfacemicromorphology of dental implants, the surfaces of commercial implantshave a wide range of available textures. It is known thatosseointegration of dental implants is dependent, in part, on theattachment and spreading of osteoblast-like cells on the implantsurface. It appears that such cells will attach more readily to roughsurfaces than to smooth surfaces, but an optimum surface for long-termstability has not yet been defined.

Wilke, H. J. et al. have demonstrated that it is possible to influencethe holding power of implants by altering surface structure morphology:“The Influence of Various Titanium Surfaces on the Interface Strengthbetween Implants and Bone”, Advances in Biomaterials, Vol. 9, pp.309-314, Elsevier Science Publishers BV, Amsterdam, 1990. While showingthat increased surface roughness appeared to provide stronger anchoring,these authors comment that it “cannot be inferred exclusively from theroughness of a surface as shown in this experiment. Obviously the shearstrength is also dependent on the kind of roughness and local dimensionsin the rough surface which can be modified by chemical treatment.”

Buser, D. et al., “Influence of Surface Characteristics on BoneIntegration of Titanium Implants”, Journal of Biomedical MaterialsResearch, Vol. 25, pp. 889-902, John Wiley & Sons, Inc., 1991, reportsthe examination of bone reactions to titanium implants with varioussurface characteristics to extend the biomechanical results reported byWilke et al. The authors state that smooth and titanium plasma sprayed(“TPS”) implant surfaces were compared to implant surfaces produced byalternative techniques such as sandblasting, sandblasting combined withacid treatment, and plasma-coating with HA. The evaluation was performedwith histomorphometric analyses measuring the extent of the bone-implantinterface in cancellous bone. The authors state, “It can be concludedthat the extent of bone-implant interface is positively correlated withan increasing roughness of the implant surface.”

Prior processes that have been used in attempts to achieve biocompatiblesurfaces on surgically implantable prosthetic devices have taken manyforms, including acid etching, ion etching, chemical milling, laseretching, and spark erosion, as well as coating, cladding and plating thesurface with various materials, for example, bone-compatible apatitematerials such as hydroxyapatite or whitlockite or bone-derivedmaterials. Examples of U.S. patents in this area are U.S. Pat. No.3,855,638 issued to Robert M. Pilliar Dec. 24, 1974 and U.S. Pat. No.4,818,559 issued to Hama et al. Apr. 4, 1989. A process of ion-beamsputter modification of the surface of biological implants is describedby Weigand, A. J. et al. in J. Vac. Soc. Technol., Vol. 14, No. 1,January/February 1977, pp. 326-331.

As Buser et al. point out (Ibid p. 890), the percentage of bone-implantcontact necessary to create sufficient anchorage to permit successfulimplant function as a load-bearing device over time remains unclear.Likewise, Wennerberg et al., “Design and Surface Characteristics of 13Commercially Available Oral Implant Systems”, Int. J. Oral MaxillofacialImplants 1993, 8:622-633, show that the different implants studiedvaried considerably in surface topography, and comment: “Which of thesurface roughness parameters that will best describe and predict theoutcome of an implant is not known” (p. 632).

Radio-frequency glow-discharge treatment, also referred to asplasma-cleaning (“PC”) treatment, is discussed in Swart, K. M. et al.,“Short-term Plasma-cleaning Treatments Enhance in vitro OsteoblastAttachment to Titanium”, Journal of Oral Implantology, Vol. XVIII, No. 2(1992), pp. 130-137. These authors comment that gas plasmas may be usedto strip away organic contaminants and thin existing oxides. Theirconclusions suggest that short-term PC treatments may produce arelatively contaminant-free, highly wettable surface. U.S. Pat. No.5,071,351, issued Dec. 10, 1991, and U.S. Pat. No. 5,188,800, issuedFeb. 23, 1993, both owned by the assignee of the present application,describe and claim methods and means for PC cleaning of a surgicalimplant to provide a contact angle of less than 20 degrees.

Copending application Ser. No. 08/149,905, filed Nov. 10, 1993, owned bythe assignee of the present application, describes and claims inventionsfor improving the surfaces of surgically implantable devices whichemploy, among other features, impacting the surface with particles ofthe same material as the device to form the surface into a desiredpattern of roughness.

SUMMARY OF THE INVENTION

It is a primary object of the present invention to produce an implantsurface having a roughness that is substantially uniform over the areaof the implant that is intended to bond to the bone in which the implantis placed.

It is a further object of this invention to provide an improvedsurgically implantable device having on its surface a substantiallyuniform micromorphology.

It is another object of the invention to provide a process or processesfor manufacturing such improved implant devices.

It is an additional object of the invention to provide such improvedimplant devices which can be manufactured without contaminating thesurfaces thereof.

It is a more specific object of the invention to provide an improvedetch-solution process that will result in a substantially uniformsurface topography on surgically implantable devices.

In accordance with the present invention, the foregoing objectives arerealized by removing the native oxide layer from the surface of atitanium implant to provide a surface that can be further treated toproduce a substantially uniform surface texture or roughness, and thenperforming a further, and different, treatment of the resulting surfacesubstantially in the absence of unreacted oxygen. The removal of thenative oxide layer may be effected by any desired technique, but ispreferably effected by immersing the implant in hydrofluoric acid underconditions which remove the native oxide quickly while maintaining asubstantially uniform surface on the implant. The further treatment isdifferent from the treatment used to remove the native oxide layer andproduces a desired uniform surface texture, preferably acid etching thesurface remaining after removal of the native oxide layer. To enhancethe bonding of the implant to the bone in which it is implanted, abone-growth-enhancing material, such as bone minerals, hydroxyapatite,whitlockite, or bone morphogenic proteins, may be deposited on thetreated surface. The implant is preferably maintained in an oxygen-freeenvironment following removal of the native oxide layer, in order tominimize the opportunity for oxide to re-form before the subsequenttreatment is performed.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagrammatic sectional view taken through a body of titaniumcovered with a layer of native oxide;

FIG. 2 is the same section shown in FIG. 1 after impacting the surfacewith a grit;

FIG. 3 is the same section shown in FIG. 2 after bulk etching with anacid etch;

FIG. 4 is the same section shown in FIG. 2 after first removing thenative oxide and then bulk etching with an acid;

FIGS. 5A and 5B are scanning electron micrographs (“SEMs”) of twotitanium dental implants prepared in accordance with the presentinvention;

FIGS. 6A and 6B are SEMs of the same implants shown in FIGS. 5A and 5B,at a higher magnification level;

FIG. 7 is a graph of the results of an Auger electron spectroscopicanalysis of a titanium surface that has been exposed to air;

FIGS. 8A and 8B are SEMs of two titanium dental implants prepared inaccordance with the present invention; and

FIGS. 9A and 9B are SEMs of the same implants shown in FIGS. 8A and 8B,at a higher magnification level.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Turning now to the drawings, and referring first to FIG. 1, a titaniumbody 10 which has been exposed to air has on its outer surface 12 anirregular layer 14 of an oxide or oxides of titanium which formnaturally. This oxide layer 14 is referred to herein as the “nativeoxide” layer, and typically has a thickness in the range from about 70to about 150 Angstroms. The native oxide layer that forms naturally ontitanium when it is exposed to air is actually a combination ofdifferent oxides of titanium, including TiO, TiO₂, Ti₂O₃ and Ti₃O₄. Theconcentration of these oxides in the titanium body diminishes withdistance from the surface of the body. The oxide concentration may bemeasured in an Auger spectrometer.

Auger electron spectroscopy (AES) measures the energy of Auger electronsproduced when an excited atom relaxes by a radiationless process afterionization by a high energy electron, ion or x-ray beam. The spectra ofa quantity of electrons emitted as a function of their energy revealinformation about the chemical environment of the tested material. Oneof the major uses of AES is the depth profiling of materials, to revealthe thickness (depth) of the oxide layer on the surfaces of materials.These Auger electrons lie in an energy level that extends generallybetween the low energy level of the emission of secondary electrons upto the energy of the impinging electron beam. In this region, smallpeaks will occur in the spectra at certain energy levels that identifythe existence of certain elements in the surface.

As used herein, the term “native oxide layer” refers to the layer whichextends from the surface of the material to the depth at which theenergy of the peak-to-peak oxygen profile as measured in an Augerelectron spectrometer decreases by one-half. For example, in thepeak-to-peak oxygen profile reproduced in FIG. 7, the thickness of thenative oxide layer was 130 Angstroms, which is the depth at which theoxygen profile dropped to half its maximum intensity. Thus, removal of a130-Angstrom layer from the surface of the titanium body would removethe native oxide layer.

FIG. 2 depicts the surface 12 of the titanium body 10 after being gritblasted to achieve initial roughening, as described in more detailbelow. The oxide layer 14 is still present, but it has a rougher surfacethan in its original state depicted in FIG. 1.

FIG. 3 depicts the grit-blasted surface 12 of the titanium body 10 afterit has been bulk etched in an etching acid. The etched area 16 where thenative oxide layer 14 has been removed by the etching acid exhibits amuch finer roughness, but in areas where the oxide layer remains, theinitial roughness depicted in FIG. 2 also remains.

FIG. 4 depicts the grit-blasted surface 12 of the titanium body 10 afterit has been etched in a first acid to remove the native oxide layer 14,and then in a second acid to produce the desired topography on thesurface 16 produced by the first acid treatment. As described in moredetail below, the preferred surface topography has a substantiallyuniform, fine roughness over the entire surface 16.

Among the processes previously used to improve the surfaces of dentalimplants made of titanium is that of etching the surface with an acid,such as a mixture of two parts (by volume) sulfuric acid and one part(by volume) muriatic acid. It has been found that such acid treatmentsdo not etch an oxidized implant surface uniformly or consistently fromone region to another.

According to one aspect of the present invention, the native oxide layeris removed from the surface of a titanium implant prior to the finaltreatment of the surface to achieve the desired topography. After thenative oxide layer is removed, a further and different treatment of thesurface is carried out in the absence of unreacted oxygen to prevent theoxide layer from re-forming until after the desired surface topographyhas been achieved. It has been found that this process permits theproduction of unique surface conditions that are substantially uniformover the implant surface that is so treated.

Removal of the native oxide layer can be effected by immersing thetitanium implant in an aqueous solution of hydrofluoric (HF) acid atroom temperature to etch the native oxide at a rate of at least about100 Angstroms per minute. A preferred concentration for the hydrofluoricacid used in this oxide removal step is 15% HF/H₂O. This concentrationproduces an etch rate of approximately 200-350 Angstroms per minute atroom temperature, without agitation, so that a typical native oxidelayer having a thickness in the range from about 70 to about 150Angstroms can be removed in about one-half minute. Other suitableetching solutions for removing the native oxide layer, and theirrespective etch rates, are:

50% HF—etch rate ˜600 to 750 Angstroms/min.

30% HF—etch rate ˜400 to 550 Angstroms/min.

10% HF—etch rate ˜100 to 250 Angstroms/min.

A 100% HF was found to be difficult to control, and the etch rate wasnot determined. The preferred 15% HF solution allows substantiallycomplete removal of the native oxide layer with minimum furtherconsumption of the titanium surface after the implant is removed fromthe solution.

The native oxide layer may be removed by the use of other acids, or bythe use of techniques other than acid etching. For example, the Swart etal. article cited above mentions the use of plasma cleaning to removethin oxides. Regardless of what technique is used, however, it isimportant to remove substantially all the native oxide from the implantsurface that is intended to interface with the living bone, so that thesubsequent treatment of that surface produces a substantially uniformsurface texture to promote uniform bonding to the living bone. Thenative oxide layer is preferably removed from substantially the entirebone-interfacing surface of the implant. In the case of screw-typedental implants, the bone-interfacing surface typically includes theentire implant surface beyond a narrow collar region on the side wall ofthe implant at the gingival end thereof. This narrow collar regionpreferably includes the first turn of the threaded portion of theimplant. It is preferred not to etch the gingival end itself, as well asthe narrow collar region, because these portions of the implant arenormally fabricated with precise dimensions to match abutting componentswhich are eventually attached to the gingival end or the implant.Moreover, it is preferred to have a smooth surface on that portion of adental implant that is not embedded in the bone, to minimize the risk ofinfection.

The treatment that follows removal of the native oxide layer must bedifferent from the treatment that is used to remove the native oxidelayer. A relatively aggressive treatment is normally required to removethe oxide layer, and such an aggressive treatment does not produce thedesired uniform surface texture in the resulting oxide-free surface.Thus, after the native oxide layer has been removed, the resultingimplant surface is immediately rinsed and neutralized to prevent anyfurther attack on the implant surface. The surface is then subjected tothe further, and different, treatment to produce a desired uniformsurface texture. For example, the preferred further treatment describedbelow is a relatively mild acid-etching treatment which forms amultitude of fine cone-like structures having relatively uniform, smalldimensions. Because of the prior removal of the native oxide layer, evena mild second treatment of the implant surface can produce asubstantially uniform effect over substantially the entirebone-interfacing surface of the implant.

Prior to removing the native oxide layer, the oxide-bearing surface maybe grit blasted, preferably with grit made of titanium or a dilutetitanium alloy. As is taught in the aforementioned copending U.S. patentapplication Ser. No. 08/149,905, the use of a grit made of titaniumavoids contaminating the surface of a titanium implant. Thus, for adental implant made of commercially pure (“CP”) titanium, the blastingmaterial may be CP B299 SL grade titanium grit. The preferred particlesize for this grit is in the range from about 10 to about 60 microns(sifted), and the preferred pressure is in the range from about 50 toabout 80 psi.

The surface treatment that follows removal of the native oxide layerfrom the implant surface may take several forms, singly or incombination. The preferred treatment is a second acid etching step,using an etch solution (“Modified Muriaticetch”) consisting of a mixtureof two parts by volume sulfuric acid (96% by weight H₂SO₄, 4% by weightwater) and one part by volume hydrochloric acid (37% by weight HCl, 63%by weight water) at a temperature substantially above room temperatureand substantially below the boiling point of the solution, preferably inthe range from about 60° C. to about 80° C. This mixture provides asulfuric acid/hydrochloric acid ratio of about 6:1. This preferred etchsolution is controllable, allowing the use of bulk etch times in therange from about 3 to about 10 minutes. This solution also can beprepared without the risk of violent reactions that may result frommixing more concentrated HCl solutions (e.g., 98%) with sulfuric acid.This second etching treatment is preferably carried out in the absenceof unreacted oxygen, and before the implant surface has been allowed tore-oxidize, following removal of the native oxide layer. Of course, theimplants may be kept in an inert atmosphere or other inert environmentbetween the two etching steps.

The second etching step produces a surface topography that includes manyfine projections having a cone-like aspect in the sub-micron size range.Because of the fine roughness of the surface, and the high degree ofuniformity of that roughness over the treated surface, the surfacetopography produced by this process is well suited for osseointegrationwith adjacent bone. As illustrated by the working examples describedbelow, the final etched surface consists of a substantially uniformarray of irregularities having peak-to-valley heights of less than about10 microns. Substantial numbers of the irregularities are substantiallycone-shaped elements having base-to-peak heights in the range from about0.3 microns to about 1.5 microns. The bases of these cone-shapedelements are substantially round with diameters in the range from about0.3 microns to about 1.2 microns, and spaced from each other by about0.3 microns to about 0.75 microns. The SEMs discussed below, andreproduced in the drawings, illustrate the surface topography in moredetail.

The acid-etched surface described above also provides a good site forthe application of various materials that can promote bonding of thesurface to adjacent bone. Examples of such materials arebone-growth-enhancing materials such as bone minerals, bone morphogenicproteins, hydroxyapatite, whitlockite, and medicaments. These materialsare preferably applied to the etched surface in the form of fineparticles which become entrapped on and between the small cone-likestructures. The bone-growth-enhancing materials are preferably appliedin the absence of oxygen, e.g., using an inert atmosphere.

The roughness of the surface to which these materials are appliedenhances the adherence of the applied material to the titanium implant.The uniformity of the rough surface enhances the uniformity of thedistribution of the applied material, particularly when the material isapplied as small discrete particles or as a very thin film.

A preferred natural bone mineral material for application to the etchedsurface is the mineral that is commercially available under theregistered trademark “BIO-OSS”. This material is a natural bone mineralobtained from bovine bone; it is described as chemically comparable tomineralized human bone with a fine, crystalline biological structure,and able to support osseointegration of titanium fixtures.

The invention will be further understood by reference to the followingexamples, which are intended to be illustrative and not limiting:

Example No. 1

A batch of 30 screw-type cylindrical implants made of CP titanium weregrit blasted using particles of CP B299 SL grade titanium grit havingparticle sizes ranging from 10 to 45 microns, at a pressure of 60 to 80psi. After grit-blasting, native oxide layer was removed from theimplant surfaces by placing 4 implants in 100 ml. of a 15% solution ofHF in water at room temperature for 30 seconds. The implants were thenremoved from the acid, neutralized in a solution of baking soda, andplaced in 150 ml. of “Modified Muriaticetch” (described above) at roomtemperature for 3 minutes. The implants were then removed from the acid,neutralized, rinsed and cleaned. All samples displayed very similarsurface topographies and a high level of etch uniformity over thesurface, when compared with each other in SEM evaluations. Consistencyin the surface features (peaks and valleys) was also observed. The SEMsin FIGS. 5A, 5B, 6A and 6B show the surfaces of two of the implants,Sample A-1 and Sample A-4, at magnifications of 2,000 and 20,000. Itwill be observed that the surface features over the areas shown areconsistent and uniform. The scale shown on the ×20,000 photographs is 1micron=0.564 inch. At this magnification the surfaces appear to becharacterized by a two-dimensional array of cones ranging in height (asseen in the SEMs) from about 0.17 inch to about 0.27 inch; the basediameters of these cones varied from about 0.17 inch to about 0.33 inch.Converting these numbers to metric units on the above-mentioned scale (1micron=0.564 inch) yields:

cone height range (approx.)=0.30 to 0.50 micron

cone base diameter range (approx.)=0.30 to 0.60 micron.

The same degree of uniformity was found in all the samples, and fromsample to sample, at magnifications of 2,000 and 20,000, as comparedwith similar samples subjected to bulk etching without prior removal ofthe native oxide, as described in EXAMPLE NO. 2 below.

Example No. 2

Four of the implants that had been grit blasted as described in EXAMPLENO. 1 above were placed in 150 ml. of “Modified Muriaticetch” for 10minutes. The implants were then removed, neutralized, rinsed andcleaned. SEM photographs taken at magnifications of 2,000 and 20,000showed that the bulk etch solution failed to remove the native oxidelayer after 10 minutes in the etch solution. The failure to remove thenative oxide layer (100-150 Angstrom units thick) resulted in anon-uniformly etched surface, as depicted in FIG. 3. In areas of theimplant surfaces where the native oxide was removed, the topography wassimilar to that observed on the implants in EXAMPLE NO. 1.

Example No. 3

The procedure of this example is currently preferred for producingcommercial implants. A batch of screw-type implants made of CP titaniumwere immersed in a 15% solution of HF in water at room temperature for60 seconds to remove the native oxide layer from the implant surfaces. Aplastic cap was placed over the top of each implant to protect it fromthe acid. The implants were then removed from the acid and rinsed in abaking soda solution for 30 seconds with gentle agitation. The implantswere then placed in a second solution of baking soda for 30 seconds,again with agitation of the solution; and then the implants were rinsedin deionized water. Next the implants were immersed in another solutionof two parts by volume sulfuric acid (96% by weight H₂SO₄, 4% by weightwater) and one part by volume hydrochloric acid (37% by weight HCl, 63%by weight water) at 70° C. for 5 minutes. The implants were then removedfrom the acid and rinsed and neutralized by repeating the same stepscarried out upon removal of the implants from the HF. All samplesdisplayed very similar surface topographies and a high level of etchuniformity over the surface, when compared with each other in SEMevaluations. Consistency in the surface features (peaks and valleys) wasalso observed. The SEMs in FIGS. 8A, 8B, 9A and 9B show the surfaces oftwo of the implants, Sample 705MB and Sample 705MC, at magnifications of2,000 and 20,000. It will be observed that the surface features over theareas shown are consistent and uniform. The scale shown on the ×20,000photographs is 1 micron=0.564 inch. At this magnification the surfacesappear to be characterized by a two-dimensional array of cones rangingin height (as seen in the SEMs) from about 0.17 inch to about 1.128inch; the base diameters of these cones varied from about 0.17 inch toabout 1.128 inch. Converting these numbers to metric units on theabove-mentioned scale (1 micron=0.564 inch) yields:

cone height range (approx.)=0.30 to 0.20 microns

cone base diameter range (approx.)=0.30 to 0.20 microns.

The same degree of uniformity was found in all the samples, and fromsample to sample, at magnifications of 2,000 and 20,000, as comparedwith similar samples subjected to bulk etching without prior removal ofthe native oxide, as described in EXAMPLE NO. 2 above.

1. A method of preparing the surface of an implant to be surgicallyimplanted in living bone and made of titanium, said implant having asurface with a native oxide layer thereon, said method comprising thesteps of: (a) removing said native oxide layer from said surface, byetching said surface with hydrofluoric acid of sufficient strength toetch the native oxide layer at a rate of at least about 100 Angstromsper minute; and (b) acid etching said surface from which said nativeoxide layer has been removed to form a surface texture.
 2. The method ofclaim 1 further including the step of depositing on said acid-etchedsurface at least one material selected from the group consisting of boneminerals, hydroxyapatite, whitlockite, bone morphogenic proteins andmedicaments.
 3. The method of claim 2, wherein said at least onematerial is in particulate form.
 4. A method of preparing a surface ofan implant made of titanium, said surface having a native oxide layerthereon, said method comprising the steps of: (a) removing said nativeoxide layer from said surface of said implant by etching said surfacewith hydrofluoric acid of sufficient strength to etch said native oxidelayer at a rate of at least about 100 Angstroms per minute; (b) removingsaid implant from said hydrofluoric acid after removal of said nativeoxide layer; and (c) before re-oxidation, immersing said implant in amixture of sulfuric acid and hydrochloric acid to produce an etchedsurface with an array of irregularities.
 5. The method of claim 4,wherein said mixture of sulfuric acid and hydrochloric acid is in anaqueous solution with the ratio of sulfuric acid to hydrochloric acidbeing approximately 5 to
 1. 6. The method of claim 5, wherein said stepof immersing occurs for about 3 to about 10 minutes.
 7. The method ofclaim 6, wherein said step of immersing is at a temperature of about 70°C.
 8. The method of claim 4 further including the step of grit blastingsaid surface prior to said step of removing said native oxide layer. 9.The method of claim 4 further including the step of depositing on saidsurface at least one material selected from the group consisting of boneminerals, hydroxyapatite, whitlockite, bone morphogenic proteins andmedicaments.
 10. A method of preparing a surface of a device that issurgically implantable in living bone, said device being made oftitanium and having a native oxide layer on said surface, said methodcomprising the steps of: (a) removing substantially all of said nativeoxide from said surface of said device; and (b) performing furthertreatment on said substantially oxide-free surface substantially in theabsence of unreacted oxygen to produce a surface with an array ofirregularities having peak-to-valley heights less than about 10 microns.11. The method of claim 10, wherein said acid etching includes immersingsaid substantially oxide-free surface in a mixture of hydrochloric acidand sulfuric acid.
 12. The method of claim 11, wherein said step ofimmersing in said mixture of hydrochloric acid and sulfuric acid occursfor about 3 to about 10 minutes.
 13. A method of preparing a surface ofa device that is surgically implantable in living bone, said devicebeing made of titanium having a native oxide layer on said surface, saidmethod comprising the steps of: (a) immersing said device inhydrofluoric acid to remove substantially all of said native oxide fromsaid surface of said device; (b) rinsing said device in a first solutionto neutralize said device; (c) immersing said device in a mixture ofsulfuric acid and hydrochloric acid at a temperature above roomtemperature to produce an acid-etched surface with a topography; and (d)rinsing said device in a second solution to neutralize said device. 14.The method of claim 13, wherein said topography includes an array ofirregularities having a peak-to-valley height of less than about 10microns.
 15. A method of preparing a surface of a device that issurgically implantable in living bone, said device being made oftitanium and having a native oxide layer on said surface, said methodcomprising the steps of: (a) removing said native oxide layer from saidsurface of said device until the depth of the peak-to-peak oxygenprofile as measured by Auger spectrometer has decreased to one-half ofthe initial profile; and (b) after said removing, performing aroughening treatment on the surface resulting from said removing toproduce a roughened surface with an array of irregularities.
 16. Themethod of claim 15, wherein said native oxide layer has a thickness ofabout 130 Angstroms.
 17. The method of claim 15, wherein said performingsaid roughening treatment is carried out before reoxidation of thesurface resulting from said removing.
 18. A method of preparing asurface of a dental implant that is to be surgically implanted in livingbone, said dental implant being made of titanium and having a nativeoxide layer on said surface, said dental implant having abone-interfacing portion on which said surface resides, a thread makinga plurality of turns around said bone-interfacing portion, and agingival end above said bone-interfacing portion, said gingival end formating with abutting components, said method comprising the steps of:(a) removing substantially all of said native oxide from said surface ofsaid dental implant to produce a substantially oxide-free surface; and(b) performing further treatment on said substantially oxide-freesurface to produce a modified surface with an array of irregularitieshaving peak-to-valley heights less than 10 microns, said modifiedsurface being located only on a portion of said plurality of turns ofsaid thread.
 19. The method of claim 18, wherein said modified surfaceis located only below a first turn of said plurality of turns that isadjacent to said gingival end.
 20. The method of claim 18, wherein saidperforming further treatment is conducted only on a region of saidbone-interfacing surface of said dental implant located outside saidgingival end.
 21. The method of claim 18, wherein said performingfurther treatment is conducted only on a region of said bone-interfacingsurface of said dental implant located below a first turn of saidplurality of turns that is adjacent to said gingival end.
 22. The methodof claim 18, wherein said performing further treatment includes acidetching.
 23. The method of claim 22, wherein said acid etching includesetching with sulfuric acid.
 24. The method of claim 22, wherein saidacid etching includes etching with hydrochloric acid.
 25. The method ofclaim 22, wherein said acid etching includes etching with a mixture ofhydrochloric acid and sulfuric acid.
 26. The method of claim 18, whereinsaid removing substantially all of said native oxide layer includes acidetching.
 27. The method of claim 26, wherein said acid etching includesetching with hydrofluoric acid.
 28. The method of claim 18, wherein saidirregularities include irregularities having peak-to-valley heights inthe range from about 0.3 microns to about 1.5 microns.
 29. A method ofpreparing a surface of a dental implant that is to be surgicallyimplanted in living bone, said dental implant being made of titanium andhaving a native oxide layer on said surface, said surface of said dentalimplant having a threaded portion with a thread making a plurality ofturns around said threaded portion, and a gingival end above saidthreaded portion, said gingival end for mating with abutting components,said method comprising the steps of: (a) performing a first treatmentthat removes native oxide from said surface; and (b) performing a secondtreatment, different from said first treatment, to produce a furtherroughened surface with an array of irregularities having peak-to-valleyheights less than 10 microns.
 30. The method of claim 29, wherein saidfurther roughened surface is located only below a first turn of saidplurality of turns that is adjacent to said gingival end.
 31. The methodof claim 29, wherein said performing a second treatment is conductedonly on a region of said dental implant located outside said gingivalend.
 32. The method of claim 31, wherein said performing a secondtreatment is conducted only on a region of said dental implant locatedbelow a first turn of said plurality of turns that is adjacent to saidgingival end.
 33. The method of claim 29, wherein said performing afirst treatment includes acid-etching.
 34. The method of claim 29,wherein said performing a first treatment includes grit-blasting priorto removing the native oxide layer.
 35. The method of claim 34, whereinsaid grit-blasting includes blasting with titanium particles.
 36. Themethod of claim 29, wherein said modified surface is located only belowa first turn of said plurality of turns that is adjacent to saidgingival end.
 37. The method of claim 29, wherein said performing asecond treatment includes acid-etching.
 38. The method of claim 29,wherein said irregularities include irregularities having peak-to-valleyheights in the range from about 0.3 microns to about 1.5 microns.
 39. Amethod of preparing a surface of a dental implant that is to besurgically implanted in living bone, the dental implant being made oftitanium and having a bone-interfacing surface including a threadedregion, the bone-interfacing surface extending from a collar regionpositioned at a gingival end of the dental implant, the collar regionhaving a smooth surface, the method comprising the acts of: performing afirst treatment on the bone-interfacing surface to remove native oxidefrom the bone-interfacing surface, the first treatment including gritblasting, the first treatment being performed outside of the collarregion to maintain the smooth surface of the collar region; and afterthe first treatment, acid-etching the bone-interfacing surface with asolution including hydrochloric and sulfuric acid at a temperature aboveroom temperature to produce a modified surface with an array ofirregularities having peak-to-valley heights less than 10 microns, theacid-etching being performed outside of the collar region to maintainthe smooth surface of the collar region.
 40. The method of claim 39,wherein the threaded region makes a plurality of turns around the dentalimplant, the collar region including a first turn of the plurality ofturns and the bone-interfacing surface including the remaining pluralityof turns.
 41. The method of claim 39, wherein the grit blasting includesblasting with titanium particles.
 42. The method of claim 39, whereinthe grit blasting includes blasting with particles having a size rangingfrom about 10 to about 60 microns.
 43. The method of claim 39, whereinthe temperature is in the range of about 60° C. to about 80° C.